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Elderly caregivers experiencing strain have a greater risk of death

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By Richard Schulz, PhD, and Scott R. Beach, PhD • • January 1, 1999

(CHICAGO) Elderly caregiving spouses who report experiencing strain are at greater risk of death than elderly spouses who are not caregivers, according to an article in the December 15 issue of The Journal of the American Medical Association (JAMA).

Richard Schulz, PhD, and Scott R. Beach, PhD, from the University of Pittsburgh, analyzed the rate of death in 4 years of 392 older spouses who were caregivers and 427 older spouses who were not caregivers to determine the relationship between the demands of caregiving and the rate of death.

The researchers found that after adjusting for sociodemographic factors (age, sex, race, education and stressful life events), prevalent disease (such as heart attack, angina pectoris, congestive heart failure, stroke), and subclinical signs of cardiovascular disease (such as abnormal electrocardiogram results), that compared to the control group of participants whose spouses were not disabled and therefore did not require care:

1. Caregivers who had experienced strain had a 63 percent higher risk of death

2. Caregivers who had not experienced strain had an 8 percent higher risk of death

3. Noncaregivers with disabled spouses had a 37 percent higher risk of death

"The data are consistent with the notion that strained caregivers with prevalent disease may be at particular risk of mortality," the authors write.
"Thirty-three percent of strained caregivers with prevalent disease in our sample died within the four-year follow-up period." Overall mortality rates were highest among study participants with prevalent disease (22.5 percent), followed by those participants with subclinical disease (11.6 percent) and those with no apparent disease (5.4 percent).

The researchers defined caregivers as those caring for a spouse who had difficulty with at least one activity of daily living because of physical or health problems or problems with confusion. The study participants were aged 66 to 96 years old (average age 80); 51 percent were women. Of those study participants with disabled spouses, approximately 81 percent were providing care and about 56 percent of those providing care reported experiencing strain.

"The higher unadjusted mortality rate among the group whose spouses were disabled but did not help appeared to be explained by their higher rates of prevalent disease. In addition, participants who were older, male, black, or had at least one prevalent disease had higher four-year mortality rates," according to the authors.

Citing earlier studies, the authors write: "By some estimates, more than 15 million adults currently provide care to relatives, saving the formal health care system billions of dollars annually. The majority of caregivers are middle-aged adult children and older spouses who care for a parent or spouse with functional limitations."

"It is important to emphasize that the caregiver-mortality link applies only to a subset of the caregiving population. This study focuses on elderly caregiving spouses who are living with the care recipient," the authors note.

The authors conclude: "Primary care physicians who care for community-residing older adults may be in the best position to identify caregivers at risk. Older married couples should be evaluated as a unit, both in terms of their health status as well as the caregiving demands that exist in the home environment. To the extent that caregiving demands are high, opportunities for restorative behaviors are limited and the caregiver is physically compromised, an intervention that reduces caregiving demands such as the provision of respite services may be needed. Under extreme circumstances, it may be appropriate to relieve a vulnerable older person from caregiving responsibilities permanently by finding an alternative caregiver or institutionalizing the care recipient. In general, it is essential that we develop treatment approaches for older marital dyads [marital pairs] that focus on the needs of both individuals simultaneously."

The research was supported in part by grants from the National Institute of Mental Health, the National Institute on Aging, the National Heart, Lung, and Blood Institute, Bethesda, Md., and the Petersen Endowed Chair scholar award from Oregon State University, Corvallis. The Cardiovascular Health Study is supported by contracts from the National Heart, Lung, and Blood Institute.

JAMA. 1999;282:2215-2219

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